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Erythematous pinta plaque — Clinical Guidelines

Overview

Erythematous pinta plaque, often associated with rosacea, presents as persistent redness and inflammation on the central face, potentially involving papules, pustules, telangiectasia, and ocular symptoms. 1 5 10

Diagnosis

Clinical Presentation: Persistent central facial erythema, flushing, papules, pustules, telangiectasia. 10 39

Diagnostic Criteria: Based on phenotype approach including erythema, papules/pustules, telangiectasia, ocular involvement. 25 33

Grading Tools: Use of scales like the Kesty Redness Scale for quantifying facial redness. 2

Differential Diagnosis: Consider conditions mimicking rosacea such as acne, perioral dermatitis, and contact dermatitis. 43 42

Management

First-Line Treatments:

- Topical Agents: Brimonidine tartrate (applied as needed for erythema), azelaic acid (15-20% gel/cream). 11 13 - Systemic Agents: Oral antibiotics (tetracyclines, especially doxycycline), particularly for inflammatory lesions. 1 10 13

Adjunctive Treatments:

- Lifestyle Modifications: Avoid triggers like spicy foods, alcohol, and extreme temperatures. 5 16 - Skin Care: Use gentle, non-irritating skincare products to support barrier function. 16 - Laser/Light Therapy: For persistent telangiectasia and erythema reduction. 19

Special Populations

Pregnancy: Limited data; avoid systemic tetracyclines; consider topical treatments cautiously. 7 37

Pediatrics: Granulomatous rosacea can occur; diagnosis challenging due to rarity; treat with caution using topical agents. 38

Elderly: Increased risk of comorbidities; consider systemic effects and interactions with existing medications. 12

Comorbidities: Rosacea associated with hypertension, dyslipidemia, inflammatory bowel disease, anxiety, and depression; manage accordingly. 12

Key Recommendations

Utilize phenotype-based classification for accurate diagnosis and tailored treatment plans. (Evidence: Moderate) 25 33

Employ topical brimonidine for acute erythema management and azelaic acid for inflammatory lesions. (Evidence: Moderate) 11 13

Integrate patient education on lifestyle modifications to mitigate rosacea triggers. (Evidence: Expert opinion) 5 16

References

1 Li S, Lin J, Yang X, Qiu X, Ruan D, Li J et al.. From signal to strategy: a disproportionality analysis of dupilumab-associated rosacea in FAERS with a summary of reported clinical cases. The Journal of dermatological treatment 2026. link 2 Kesty CE, Kesty KR. The Kesty Redness Scale: A Pilot Validation Study for a Novel Tool for Evaluating Facial Redness in Cosmetic and Clinical Dermatology. Journal of cosmetic dermatology 2025. link 3 Gao Y, Yang XJ, Zhu Y, Yang M, Gu F. Association between rosacea and helicobacter pylori infection: A meta-analysis. PloS one 2024. link 4 Liang J, Chen Y, Wang Z, Wang Y, Mu S, Zhang D et al.. Exploring the association between rosacea and acne by integrated bioinformatics analysis. Scientific reports 2024. link 5 Patel NV, Gupta N, Shetty R. Preferred practice patterns and review on rosacea. Indian journal of ophthalmology 2023. link 6 Chernyshov PV, Finlay AY, Tomas-Aragones L, Steinhoff M, Manolache L, Pustisek N et al.. Quality of life measurement in rosacea. Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa. Journal of the European Academy of Dermatology and Venereology : JEADV 2023. link 7 Suarez MV, Francesconi F, Gonçalves H, Dal Forno T, Ribeiro BM, Mulinari-Brenner F et al.. Epidemiological profile of rosacea in dermatology outpatient clinics in Brazil: an observational report from the Brazilian study group on rosacea. European journal of dermatology : EJD 2023. link 8 Fuller J, Murphy M, O'Connor C. Red-faced lies: a qualitative analysis of online misinformation and conspiracy theories in rosacea. Clinical and experimental dermatology 2023. link 9 F K Islam Y, P Horn E. Scleral Discoloration Because of Minocycline Use: A Case Report and Review of the Literature. Military medicine 2023. link 10 Clanner-Engelshofen BM, Bernhard D, Dargatz S, Flaig MJ, Gieler U, Kinberger M et al.. S2k guideline: Rosacea. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2022. link 11 Saki N, Amani M, Nezhad NZ, Shahpar A, Shafiei M, Hosseini SA et al.. Efficacy and safety of topical brimonidine in dermatology: A review article. Dermatologic therapy 2022. link 12 Yi JZ, Chen SX, Lukac D, McGee JS. Systemic comorbidities of rosacea: practice gaps among dermatologists. Archives of dermatological research 2022. link 13 Searle T, Ali FR, Al-Niaimi F. The versatility of azelaic acid in dermatology. The Journal of dermatological treatment 2022. link 14 Hilbring C, Augustin M, Kirsten N, Mohr N. Epidemiology of rosacea in a population-based study of 161,269 German employees. International journal of dermatology 2022. link 15 Chung BY, Kim HO, Park CW, Yang NG, Kim JY, Eun YS et al.. Relationships of Serum Homocysteine, Vitamin B. BioMed research international 2022. link 16 Baldwin H, Alexis AF, Andriessen A, Berson DS, Farris P, Harper J et al.. Evidence of Barrier Deficiency in Rosacea and the Importance of Integrating OTC Skincare Products into Treatment Regimens. Journal of drugs in dermatology : JDD 2021. link 17 Oliveira CMM, Almeida LMC, Bonamigo RR, Lima CWG, Bagatin E. Consensus on the therapeutic management of rosacea - Brazilian Society of Dermatology. Anais brasileiros de dermatologia 2020. link 18 Stein Gold L, Baldwin H, Harper JC. Rationale for Use of Combination Therapy in Rosacea. Journal of drugs in dermatology : JDD 2020. link 19 Jung YJ, Ro YS, Ryu HJ, Kim JE. Therapeutic effects of a new invasive pulsed-type bipolar radiofrequency for facial erythema associated with acne vulgaris and rosacea. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology 2020. link 20 Beran D, Stepanov A, Studnička J, Jirásková N. Ocular Symptoms of Rosacea. Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti 2020. link 21 Cices A, Alexis AF. Patient-focused Solutions in Rosacea Management: Treatment Challenges in Special Patient Groups. Journal of drugs in dermatology : JDD 2019. link 22 Juliandri J, Wang X, Liu Z, Zhang J, Xu Y, Yuan C. Global rosacea treatment guidelines and expert consensus points: The differences. Journal of cosmetic dermatology 2019. link 23 van Zuuren EJ, Fedorowicz Z, Tan J, van der Linden MMD, Arents BWM, Carter B et al.. Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments. The British journal of dermatology 2019. link 24 Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience. Journal of the American Academy of Dermatology 2019. link 25 Tan J, Berg M, Gallo RL, Del Rosso JQ. Applying the phenotype approach for rosacea to practice and research. The British journal of dermatology 2018. link 26 Walsh RK, Endicott AA, Shinkai K. Diagnosis and Treatment of Rosacea Fulminans: A Comprehensive Review. American journal of clinical dermatology 2018. link 27 Mantovani L, Zauli S, Virgili A, Bettoli V. Rosacea fulminans or acute rosacea? Report of 5 cases and review of the literature. Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia 2016. link 28 Hu L, Alexander C, Velez NF, Yang C, Canales AL, Liu S et al.. Severe Tacrolimus-Induced Granulomatous Rosacea Recalcitrant to Oral Tetracyclines. Journal of drugs in dermatology : JDD 2015. link 29 Ozkol HU, Calka O, Akdeniz N, Baskan E, Ozkol H. Rosacea and exposure to tandoor heat: Is there an association?. International journal of dermatology 2015. link 30 Davis SA, Feldman SR. Patterns of ambulatory care usage and leading treatments for rosacea. The Journal of dermatological treatment 2014. link 31 Tan J, Liu H, Leyden JJ, Leoni MJ. Reliability of Clinician Erythema Assessment grading scale. Journal of the American Academy of Dermatology 2014. link 32 Olazagasti J, Lynch P, Fazel N. The great mimickers of rosacea. Cutis 2014. link 33 Tidman MJ. Improving the management of rosacea in primary care. The Practitioner 2014. link 34 Cribier B. Medical history of the representation of rosacea in the 19th century. Journal of the American Academy of Dermatology 2013. link 35 Cribier B. The red face: art, history and medical representations. Annales de dermatologie et de venereologie 2011. link70086-2) 36 Fleischer AB. Inflammation in rosacea and acne: Implications for patient care. Journal of drugs in dermatology : JDD 2011. link 37 Jarrett R, Gonsalves R, Anstey AV. Differing obstetric outcomes of rosacea fulminans in pregnancy: report of three cases with review of pathogenesis and management. Clinical and experimental dermatology 2010. link 38 da Costa JB, Coutinho VS, de Almeida LS, Gomes MM. Granulomatous rosacea in infants. Report of three cases and discussion of the differential diagnosis. Dermatology online journal 2008. link 39 Diamantis S, Waldorf HA. Rosacea: clinical presentation and pathophysiology. Journal of drugs in dermatology : JDD 2006. link 40 Margolis DJ. Evidence-based dermatology. Cutis 2005. link 41 Antille C, Saurat JH, Lübbe J. Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment. Archives of dermatology 2004. link 42 Feldman SR, Hollar CB, Gupta AK, Fleischer AB. Women commonly seek care for rosacea: dermatologists frequently provide the care. Cutis 2001. link 43 Engasser PG, Hogan DJ, Stewart LA, Zug KA. Evaluation and management of the "red face". Interview by K. Watsky and M. Rothe. American journal of contact dermatitis : official journal of the American Contact Dermatitis Society 1999. link 44 Chalmers DA. Rosacea: recognition and management for the primary care provider. The Nurse practitioner 1997. link 45 Akamatsu H, Oguchi M, Nishijima S, Asada Y, Takahashi M, Ushijima T et al.. The inhibition of free radical generation by human neutrophils through the synergistic effects of metronidazole with palmitoleic acid: a possible mechanism of action of metronidazole in rosacea and acne. Archives of dermatological research 1990. link 46 Riefkohl R, Georgiade GS, Barwick WJ, Georgiade NG. Rhinophyma: a thirty-five-year experience. Aesthetic plastic surgery 1983. link

Erythematous pinta plaque